Advance Directives and Advance Care Planning: Legal and Policy Issues

This paper begins with a brief synopsis of the common law and constitutional underpinnings of advance directive policy. Section III examines the incremental evolution of the relevant statutory law, followed by an analysis of a fundamental paradigm shift in public policy in Section IV. Then, Section V turns to a description of a possible next step in evolution, represented by the POLST paradigm. Because only a minority of the adult population has historically used advance directives, Section VI fills in the rest of the surrogate landscape by addressing health care decision making authority where there is no advance directive in place. Finally, the federal role in health care advance care planning policy is examined in Section VII. [39 PDF pages]